MaineCare Benefits Manual, Chapter II Section 97, Private Non-Medical Institution Services

Notice of Agency Rule-making Proposal

 

AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy

 

CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II Section 97, Private Non-Medical Institution Services

 

PROPOSED RULE NUMBER:

 

CONCISE SUMMARY:

 

The Department of Health and Human Services (the “Department”) proposes the following changes to 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter II, Section 97, Private Non-Medical Institution Services.

 

The Department proposes this rule to align requirements with the Family First Prevention Services Act (FFPSA), which establishes standards for children in residential treatment programs in order to improve quality and oversight of services. These proposed changes are specific to Private Non-Medical Institution (PNMI) Appendix D Facilities, and are reflected in the definitions, eligibility for care, covered services and policies and procedures sections of this rule. Additionally, as directed under the FFPSA, the proposed rule includes requirements for Appendix D providers to meet Qualified Residential Treatment Programs (QRTP) standards which include obtaining and maintaining specified licensing and accreditation standards, as well as delivering trauma-informed treatment.

 

For compliance with the FFPSA related to improving quality and oversight of services, the Department proposes to amend Appendix D language referring to Child Care Facility Services and Models of Child Care Facilities, to be replaced with the term Children’s Residential Treatment Facilities (RTFs). The proposed rule distinguishes models of residential care that address specific treatment needs of different member populations. RTF models will include Intellectual Disabilities/Developmental Disabilities (ID/DD-RTF), Mental Health (MH-RTF), Crisis Stabilization (CS-RTF), and Child and Adolescent Therapeutic Foster Care. This rule further proposes amending language referring to “Intensive Temporary Residential Treatment Services” by replacing this with the term “Temporary High Intensity Services” and including language clarifying the covered services while also establishing the requirement for a Prior Authorization process.

 

The rule also proposes the use of Department-approved, age appropriate Level of Care/Service Intensity tools, which will be required as a component of eligibility determination for ID/DD, MH, and CS RTFs. The Level of Care/Service Intensity tools will replace outdated instruments, to include the Child and Adolescent Functional Assessment Scale (CAFAS), the Children’s Global Assessment Scale (C-GAS), the Global Assessment Functioning (GAF), and the Children’s Habilitation Assessment Tool (CHAT); and streamline the process by utilizing one tool that is evidence based and clinically appropriate by age, to include the Early Childhood Service Intensity Instrument (ECSII), the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) and the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).

 

Additionally, this rule proposes various new covered services, including Aftercare Support Services, which are designed to promote a continuation of treatment gains with the goal of supporting the child in their home and community environment, and must be provided to youth for at least six (6) months post discharge from an RTF. The Department is additionally proposing a new required position, a Family Transition Specialist (FTS), to aid in the delivery of aftercare and transition services for the youth and family.

To further align with the FFPSA to achieve improved quality and oversight of services, this proposed rule clarifies Appendix D requirements for disclosure and informed consent, RTF assessment, Individual Treatment Plan, progress notes, and discharge summary as well as adding various new defined terms.

 

The Department additionally proposes that providers operating under Appendix D and Adolescent Residential Rehabilitation Services providers operating under Appendix B demonstrate utilization of the Federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) System of Care Principles and delivery of trauma-informed care through the completion of a Trauma-Informed Agency Assessment, staff training and incorporation of these principles into program policy and procedures.

 

The Department also proposes specific requirements regarding background checks for providers operating under Appendix D and Adolescent Residential Rehabilitation Services providers operating under Appendix B. The Department proposes that children’s residential facility providers must follow the requirements set forth in 22 M.R.S. § 8110 and 42 U.S.C. § 671(20). Behavioral Health Services providers must conduct background checks every five (5) years and fingerprinting. The proposed rule requires completed background checks for all staff and all adults providing services to a member within ninety (90) days of the effective date of this rule and that all background checks are to be completed every five (5) years thereafter.

 

The Department further proposes, under Appendix D, the addition of Behavioral Health Professionals (BHP) and Family Transitional Specialists (FTS) as Other Qualified Residential Treatment Facility Staff as well as including Board Certified Behavior Analyst services, Registered Behavior Technician services and Board Certified Assistant Behavior Analyst services. As a requirement under 10-144 C.M.R. ch. 128, Certified Nursing Assistant and Direct Care Worker Registry Rule, the Department is requiring confirmation that prospective BHPs are not annotated in the registry prior to qualifying as a staff member under this rule.

 

In addition to the above proposed changes, the Department proposes to increase access to necessary services by removing the ‘single admission’ limitation and increasing the number of allowable covered days for Halfway House and Extended Care Services under PNMI Appendix B of this rule. The Department also proposes edits to language to accurately reflect current practices as well as updates to formatting, citations, and references where necessary, including changes to address potentially stigmatizing language based on recommendations from the Maine’s opioid task force and legislation passed in 2018 to minimize stigma (P.L. 2017, ch. 407).

 

The Department shall seek CMS approval for the new covered services and provider requirements, as specifically noted in various proposed rule changes.

 

In addition, the Department intends to implement corresponding changes as needed in the MBM, Ch. III, Section 97, to ensure adequate reimbursement for providers to deliver all new covered services and meet QRTP standards and other Ch. II-related updates. For example, Ch. III Appendix D Sec. 2400.1 must be updated in order to ensure that rates cover the costs of Board Certified Behavior Analysts and the other new types of direct service staff. The Ch. III, Sec. 97 rule is major substantive, and the upcoming changes shall be filed as an emergency rule no later than Nov. 1, 2021, so that they will be effective at the same time the changes in Ch. II, Sec. 97 are finally adopted.

 

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

 

STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; 22 M.R.S. § 8110; 42 U.S.C. § 671(20); P.L. 2019, ch. 407; The Family First Prevention Services Act, Public Law 115-123 (as part of Division E in the Bipartisan Budget Act of 2018 (H.R. 1892) (eff. Feb. 9, 2018) (as Amended through P.L. 116–260, enacted December 27, 2020)

 

PUBLIC HEARING:

 

No public hearing scheduled. The Department will be providing a 30-day comment period instead of a public hearing.

 

DATE FILED WITH THE SECRETARY OF STATE’S OFFICE: August 3, 2021

 

30-DAY DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on September 10, 2021.

 

AGENCY CONTACT PERSON:       Melanie Miller, Comprehensive Health Planner II

                                                                Melanie.Miller@maine.gov

AGENCY NAME:                                MaineCare Services

ADDRESS:                                            109 Capitol Street, 11 State House Station

                                                                Augusta, Maine 04333-0011

 

TELEPHONE:                                      207-624-4087 FAX: (207) 287-6106

                                                                TTY: 711 (Deaf or Hard of Hearing)

 

IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.

 

CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A